Bill Status of HB 4096   100th General Assembly

Short Description:  MEDICAID-MCO-PREFERRED RX LIST

House Sponsors
Rep. Gregory Harris-Juliana Stratton-Mary E. Flowers-Sara Feigenholtz-William Davis, Robyn Gabel, La Shawn K. Ford, Jaime M. Andrade, Jr., Kelly M. Cassidy, Cynthia Soto, Rita Mayfield, Laura Fine, Kathleen Willis, Elizabeth Hernandez, Michelle Mussman, Thaddeus Jones, Carol Ammons, Camille Y. Lilly, Theresa Mah, Sam Yingling, Emanuel Chris Welch, Robert Martwick and Natalie A. Manley

Senate Sponsors
(Sen. Heather A. Steans-Daniel Biss-Laura M. Murphy-Cristina Castro, Kimberly A. Lightford, Patricia Van Pelt, Mattie Hunter and Kwame Raoul)


Last Action  View All Actions

DateChamber Action
  11/28/2018HouseTotal Veto Stands - No Positive Action Taken

Statutes Amended In Order of Appearance
305 ILCS 5/5-16.11

Synopsis As Introduced
Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services shall require each Medicaid Managed Care Organization to list as preferred on the Medicaid Managed Care Organization's preferred drug list every pharmaceutical that is listed as preferred on the Department's preferred drug list. Provides that the Department shall not prohibit, or adopt any rules or policies that prohibit, a Medicaid Managed Care Organization from: (i) covering additional pharmaceuticals that are not listed on the Department's preferred drug list; or (ii) removing from the Medicaid Managed Care Organization's preferred drug list any prior approval requirements applicable under the Department's preferred drug list. Provides that the Department shall not require a Medicaid Managed Care Organization to utilize a single, statewide preferred drug list and shall not prohibit a plan from negotiating drug pricing concessions or rebates on any drug with pharmaceutical companies, unless otherwise required by federal law. Provides that no later than July 1, 2018, the Department shall develop a standardized format for all Medicaid Managed Care Organization preferred drug lists in cooperation with Medicaid Managed Care Organizations and stakeholders, including, but not limited to, community-based organizations, providers, and individuals or entities with expertise in drug formulary development. Requires each Medicaid Managed Care Organization to post its preferred drug list on its website without restricting access to enrolled members and to update the preferred drug list posted on its website within 2 business days of making any changes to the preferred drug list, including, but not limited to, any and all changes to requirements for prior approval. Effective immediately.

House Floor Amendment No. 1
Replaces everything after the enacting clause. Amends the Medical Assistance Article of the Illinois Public Aid Code. Requires Medicaid managed care organizations (rather than managed care entities) that provide services under the Code to use a pharmacy formulary that is no more restrictive by drug class than the Department of Healthcare and Family Services' preferred drug list (rather than the Department's pharmaceutical program). Provides that beginning January 1, 2019 and continuing through January 1, 2022, the Department shall require each Medicaid managed care organization to list as preferred on the Medicaid managed care organization's preferred drug list at least the same number, and no fewer, of drugs per drug class as are listed on the Department's preferred drug list. Prohibits the Department from adopting any rules or policies that prohibit a Medicaid managed care organization from: (1) covering additional drugs that are not listed on the Department's preferred drug list; (2) submitting all covered drugs listed on the Department's preferred drug list and additional drugs covered by the Medicaid managed care organization as qualified encounters to be used for appropriate purposes; or (3) removing from the Medicaid managed care organization's preferred drug list any prior approval requirements, step therapy, or other utilization controls applicable under the Department's preferred drug list. Requires the Department to develop a standardized format for all Medicaid managed care organization preferred drug lists by January 1, 2019 and to allow Medicaid managed care organizations 6 months from the completion date of the standardized format to comply with the new Preferred Drug List format. Requires each Medicaid managed care organization to post its preferred drug list on its website without restricting access and to update the preferred drug list posted on its website no less than 30 days prior to the date upon which any update or change takes effect. Requires the Department to establish, no later than January 1, 2019, the Illinois Pharmacy and Therapeutics Advisory Board to have the authority and responsibility to provide recommendations to the Department regarding which drug products to list on the Department's preferred drug list. Contains provisions concerning Board meetings and correspondence; the Board's composition; voting and non-voting members; and other matters. Requires the Department to adopt rules, to be in place no later than January 1, 2019, for the purpose of establishing and maintaining the Board. Effective immediately.

Actions 
DateChamber Action
  9/15/2017HouseFiled with the Clerk by Rep. Gregory Harris
  9/19/2017HouseAdded Co-Sponsor Rep. Robyn Gabel
  9/20/2017HouseAdded Co-Sponsor Rep. La Shawn K. Ford
  9/20/2017HouseAdded Co-Sponsor Rep. Jaime M. Andrade, Jr.
  9/20/2017HouseAdded Co-Sponsor Rep. Kelly M. Cassidy
  9/20/2017HouseAdded Co-Sponsor Rep. Cynthia Soto
  9/20/2017HouseAdded Co-Sponsor Rep. Rita Mayfield
  9/20/2017HouseAdded Co-Sponsor Rep. Laura Fine
  9/20/2017HouseAdded Co-Sponsor Rep. Kathleen Willis
  9/20/2017HouseAdded Co-Sponsor Rep. Elizabeth Hernandez
  9/20/2017HouseAdded Chief Co-Sponsor Rep. Mary E. Flowers
  9/20/2017HouseAdded Chief Co-Sponsor Rep. Sara Feigenholtz
  9/20/2017HouseChief Co-Sponsor Changed to Rep. Mary E. Flowers
  9/22/2017HouseAdded Co-Sponsor Rep. Michelle Mussman
  9/25/2017HouseAdded Co-Sponsor Rep. Thaddeus Jones
  10/6/2017HouseAdded Chief Co-Sponsor Rep. Juliana Stratton
  10/12/2017HouseFirst Reading
  10/12/2017HouseReferred to Rules Committee
  10/17/2017HouseAssigned to Appropriations-Human Services Committee
  10/26/2017HouseDo Pass / Short Debate Appropriations-Human Services Committee; 010-006-000
  10/26/2017HousePlaced on Calendar 2nd Reading - Short Debate
  10/26/2017HouseAdded Chief Co-Sponsor Rep. William Davis
  10/26/2017HouseAdded Co-Sponsor Rep. Carol Ammons
  10/26/2017HouseSecond Reading - Short Debate
  10/26/2017HousePlaced on Calendar Order of 3rd Reading - Short Debate
  10/26/2017HouseAdded Co-Sponsor Rep. Camille Y. Lilly
  12/15/2017HouseRule 19(b) / Re-referred to Rules Committee
  1/30/2018HouseApproved for Consideration Rules Committee; 004-000-000
  1/30/2018HousePlaced on Calendar Order of 3rd Reading - Short Debate
  2/28/2018HouseAdded Co-Sponsor Rep. Theresa Mah
  3/7/2018HouseAdded Co-Sponsor Rep. Sam Yingling
  3/8/2018HouseAdded Co-Sponsor Rep. Emanuel Chris Welch
  3/8/2018HouseAdded Co-Sponsor Rep. Robert Martwick
  4/11/2018HouseAdded Co-Sponsor Rep. Natalie A. Manley
  4/23/2018HouseHouse Floor Amendment No. 1 Filed with Clerk by Rep. Gregory Harris
  4/23/2018HouseHouse Floor Amendment No. 1 Referred to Rules Committee
  4/24/2018HouseHouse Floor Amendment No. 1 Rules Refers to Appropriations-Human Services Committee
  4/26/2018HouseHouse Floor Amendment No. 1 Recommends Be Adopted Appropriations-Human Services Committee; 009-006-000
  4/26/2018HouseRecalled to Second Reading - Short Debate
  4/26/2018HouseHouse Floor Amendment No. 1 Adopted
  4/26/2018HousePlaced on Calendar Order of 3rd Reading - Short Debate
  4/26/2018HouseThird Reading - Short Debate - Passed 070-037-000
  5/1/2018SenateArrive in Senate
  5/1/2018SenatePlaced on Calendar Order of First Reading
  5/1/2018SenateChief Senate Sponsor Sen. Heather A. Steans
  5/1/2018SenateFirst Reading
  5/1/2018SenateReferred to Assignments
  5/1/2018SenateAdded as Alternate Chief Co-Sponsor Sen. Daniel Biss
  5/1/2018SenateAdded as Alternate Chief Co-Sponsor Sen. Laura M. Murphy
  5/1/2018SenateAdded as Alternate Chief Co-Sponsor Sen. Cristina Castro
  5/2/2018SenateAssigned to Special Committee on Oversight of Medicaid Managed Care
  5/3/2018SenateAdded as Alternate Co-Sponsor Sen. Kimberly A. Lightford
  5/10/2018SenateDo Pass Special Committee on Oversight of Medicaid Managed Care; 007-002-000
  5/10/2018SenatePlaced on Calendar Order of 2nd Reading May 15, 2018
  5/11/2018SenateAdded as Alternate Co-Sponsor Sen. Patricia Van Pelt
  5/16/2018SenateSecond Reading
  5/16/2018SenatePlaced on Calendar Order of 3rd Reading May 17, 2018
  5/17/2018SenateAdded as Alternate Co-Sponsor Sen. Mattie Hunter
  5/23/2018SenateAdded as Alternate Co-Sponsor Sen. Kwame Raoul
  5/23/2018SenateThird Reading - Passed; 047-009-000
  5/23/2018HousePassed Both Houses
  6/21/2018HouseSent to the Governor
  8/20/2018HouseGovernor Vetoed
  11/13/2018HousePlaced on Calendar Total Veto
  11/28/2018HouseTotal Veto Stands - No Positive Action Taken

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